Local and national

Two posts on Sarah Palin in a row – that’s not what we’re meant to be about here. So let’s talk about the state of central/local relationships in UK government.

As the case of Baby P showed, the political field of combat in the UK is definitely at national rather than local level. Over the past week, Parliament and national media have dominated the coverage, while the commentary on the case, as on wider local government issues, often implied that Haringey Council was a client or subordinate arm of national government. In fact, although elements of local service delivery are controlled by national bodies like the NHS and JobCentre Plus, local democratic mandates are theoretically independent of national ones, as I’ve mentioned before.

Over the last twenty years or so, more and more elements of local government have been nationalised or quangified, to the extent that even business rates are set nationally and redistributed to authorities in whatever Whitehall considers to be a fair proportion. Only 25% (on average) of local council spend is raised locally through the council tax, most of the rest coming in the form of grants with more or less discretion for local politicians.

The impact of this disempowerment on local government morale and self-image is hardly surprising. It also feeds through into turnouts for local government elections that are half that of general elections.

Beyond the woe, however, the Government has been talking a good talk on returning powers to local government. In some cases, such as the wellbeing power and the Sustainable Communities Act, there have been genuine moves in the direction of enabling local discretion and withdrawing national level interference where it isn’t helpful. Progress is halting and reversible, however, and the ideology of localism is still one for technocrats and managers rather than the press and public.

From a democracy perspective, more autonomy for local councils over local issues would be a good thing. An important part of democratic governance is getting responsibility for issues to the right level, whether European for trade negotiation or parish for the location of the new park bench. Many of the decisions that affect local communities, such as health care or skills provision, are rightly decided in the local area by Primary Care Trusts and local Learning and Skills Councils, but they are not decided with a local democratic mandate.

There are two big challenges to the further spread of local autonomy – one of them political and one practical. Politically, a new Conservative government would certainly find themselves in the same situation that Labour did in 1997: in charge of a sprawling bureaucracy whose members they don’t entirely trust, and with a set of manifesto pledges that they want to start work on right away. The Labour solution was a burst of centralism and target-setting, and for all the rhetoric in opposition, it’s hard to see the Conservative party in power avoiding a similar move. This isn’t a political point – it’s a sort of bureaucratic Kübler-Ross cycle, where well-meant enthusiasm for local solutions is replaced by dissatisfaction at slow delivery, and then harder and harder beatings to get delivery agencies to conform.

The larger, and more immediate, challenge is the practical one of balancing effectiveness and democratic accountability in delivery of local services centred around individuals. If we are moving towards a public service model centred around the user, many of the budgetary and political implications are only sketchily understood.

It is easiest to see the start of user-centred working in the health and social care fields. Consider the case of someone with moderate long-term health and social care needs – such as an elderly person who can still live at home but needs regular intensive support. This service user will take services from the NHS, particularly if she has a chronic condition, but will also take services from local government for social care needs. In theory, these services should all join up to provide a seamless service, and if this is actually achieved it will be through case conferences and better inter-service communication. There may even be an element of shared budgets or shared administrative arrangements, though these are more common for children’s services at the moment.

This isn’t a bad arrangement, and is a lot better than it was a few years ago. It’s a model that works adequately for a small number of service users, who are in intensive contact with health and social care services. There are approaches being tried in various places that can add worklessness and skills support into this joined-up service.

Even in the best examples, however, some services will be left out. The waste collection service won’t be in on the case conference, even though our patient might need special collection arrangements. Benefits agencies such as DWP are often unable or unwilling to share or flex their budgets to reflect individual circumstances, for fear of creating a ‘postcode lottery’.

Politics and accountability arrangements often block more radical advances. Take hospitals by way of an example. If hospitals were under local democratic control rather than bureaucratic control with a national democratic overlay, the country would certainly have more hospitals than it currently has. Local voters hate the closure or downgrading of hospitals, and the pressure on councils to keep them open at all costs would be immense. Even if medical opinion would suggest (as it does) that fewer, bigger, more specialist hospitals improve outcomes, local democratic decisions on hospital services would probably favour small local generalist units.

Hospitals are a big, capital-intensive example of the wider clash of mandates. If local authorities want local money to be used in one way, and the nationally-driven service providers want it to be used in a different way, who should prevail? And if local service spending is going to be joined up at an individual and strategic level, who takes the final decisions on the funding?

At the moment, the answer is a squashy consensus between local politicians and the managers of nationally-led services. This is not a long-term solution, however, and if something more stable is needed, I would suggest that the local level is the right place to take those decisions.

Go back to the hospital example. Would it be such a bad thing if local passions kept small generalist hospitals open? It doesn’t prevent the creation of large specialist units, it just requires the continued provision of services in a local physical setting that people can walk past every day and feel good about. That’s good politics.

Local discretion on this sort of spend would also give local authorities a wider and more coherent field of action – why could much-loved hospitals not become joint health and social care centres, or have skills and training units attached? At the moment the iron walls between NHS and local government spend prevent it, without a long period of budgetary and legal negotiations. If local authorities did have the final say over that expenditure, the decision would be simple.

It’s also unfair to suggest that local authorities would automatically give in to voters’ desires. After all, local authorities look after schools, which raise equally strong feelings among voters, and failing schools are often closed even in the teeth of public protests. At the moment, opposing hospital closures is an easy political win for councillors, who can be seen to be battling for their constituents without having to worry about the consequences for the NHS. If service design were in their remit, they would need to be more analytical and more circumspect.

If governments local and national are going to redesign services around users, they need to break down the artificial financial barriers that give Brighton, for instance, a police station, council offices, law courts, a NHS primary care trust, a general hospital and a specialist hospital in different buildings scattered around the city. To break those barriers down, however, the decisions must be based on a secure democratic foundation, through giving the local authority the final say over the money issues. It may need hard conversations in Whitehall, and it will certainly result in a plethora of nationally-prescribed service standards, but the fundamental point remains: you can’t provide individual services to someone in Newcastle from a desk in Parliament Street.